Newcomers to Southcentral Pennsylvania sometimes visit Dr. Donald Harper at Medical Arts Allergy’s offices in Carlisle or Mechanicsburg looking for answers.
They arrive at the office with classic allergy symptoms, but tests for animal, mold or pollen allergies are negative.
“What is it in moving from Rehoboth Beach, Del., to Carlisle that would give you these symptoms?” Harper asks.
He answers his own question — “It’s the reaction to the particulate in the area, not necessarily an allergic reaction.”
Particulates are tiny particles in the air that make up part of what we call air pollution. The nose just doesn’t like particulates in the air so it works as a filter to remove them, Harper said.
“If there’s lots of stuff for your nose to filter, it’s going to create a lot of mucus to capture that stuff,” Harper said.
Allergies, however, are a specific reaction to a specific trigger, he said.
According to the American Lung Association, more than 40 percent of people in the United States live in areas where air pollution threatens their health. That means more than 127 million people are living in areas with dangerous levels of either ozone or particle pollution that can cause wheezing and coughing, asthma attacks, heart attacks and premature death.
Those at greatest risk from air pollution include infants, children, older adults, anyone with lung diseases like asthma, people with heart disease or diabetes, people with low incomes and anyone who works or exercises outdoors.
Harper said more and more studies show the risk of allergies and asthma to be linked to particulates in air pollution, of which diesel exhaust is one factor.
The medical journal PLOS Medicine last week published a study looking at the link between particulate matter and cardiovascular disease.
In the study, MESA Air enrolled almost 7,000 people of different ethnicities between the ages of 45 and 84 with no symptoms of cardiovascular disease. All of the people lived in six U.S. metropolitan areas, according to the study, which began in 2000.
The study’s findings suggest that higher long-term particulate matter concentrations are associated with increased progression of carotid intima-medial thickness, or the thickening of the innermost layers of the arterial wall. The study also found that reduction of particulate matter in the air was associated with slower progression of IMT.
Through the study and previous research associating particulate matter with cardiovascular disease, researchers believe people living in parts of the town with higher particulate matter readings have an increased risk of stroke compared to people living in less polluted regions in even the same metropolitan area.
Also in this form of air pollution, the particles are small enough to breathe in and cause inflammation, which is particularly dangerous for people with asthma.
“Air pollution is clearly recognized as a trigger for asthma attacks,” said Kevin M. Stewart, director of environmental health for American Lung Association of the Mid-Atlantic Region.
Air pollution makes attacks stronger, more frequent and more severe, Stewart said. Symptoms also last longer.
“Asthma is a disease that kills people,” Stewart said. “There are thousands of deaths every year from asthma attacks that get out of hand and emergency treatment isn’t found or isn’t effective.”
Asthma has different symptoms in different patients. Some people have difficulty with lung function and others might not realize their ability to take air in and out has been compromised, Stewart said.
“This is where adults who are observing children have to pay attention,” he said.
Think of a child on a playground who is normally active and keeping up with everyone else. “If there’s maybe problems with air pollution exposure, they may not have quite the stamina to do more active things,” Stewart said.
Harper said there is an increased instance of allergies and asthma along freeway systems, which is also where many schools are located.
Harper said there’s absolutely a connection between air pollution and allergies, though he’s not sure that it’s on the increase.
“We certainly have more and more data that it’s a problem,” he said.
Whatever is causing it, Kellie Smith of Camp Hill knows that living in Cumberland County has exascerbated her allergies.
With a stepfather who moved the family around because of his job and a husband in the military who also moved frequently, Smith has lived in a variety of places all over the globe. From England to Texas to Oklahoma to Ohio, Smith has lived in quite a few places before moving to New Cumberland in 1999.
“I was rarely affected by allergies until I came here,” Smith said. “I had mild allergies every now and then, but it became severe when I moved to Pennsylvania.”
Smith said she used to have annual sinus infections and almost always woke up to watering eyes and trouble breathing.
“I was living on antihistamines, and it still wouldn’t help me,” she said.
The wheezing and trouble breathing worried her the most, and Smith decided to finally get additional support before she developed asthma. She started receiving allergy shots and is currently in the maintenance phase of the medication.
“Since I started the allergy medication, it’s helped,” Smith said. “It was getting really out of control.”
Working with a physician is vital. Stewart said children are not too young to do a peak flow monitoring test to test lung function and to learn how to manage lung function.
Stewart said there’s a growing body of evidence that ozone — another component of air pollution — is linked to premature death.
People don’t show up at the emergency department or the morgue with a little red tag that says “air pollution did this to me,” Stewart said. Doctors, however, look at people who are known to have been exposed to higher level of air pollution and experience a death from a disease that makes epidemiological sense to be connected to those pollution levels.
“You will see that the people who are presenting with those problems are present at higher numbers than if it was simply by chance,” Stewart said.
Though air quality standards are defined on a well-established scientific basis, Stewart said the American Lung Association frequently pushes the Environmental Protection Agency for stronger regulations because continuing health issues show the current standards to not be as stringent as they need to be.
While the association works toward more stringent standards, it’s up to the individual to minimize the risk of exposure to harmful pollutants.
“Avoidance is important,” Harper said. “If you can avoid those exposures that are going to trigger those symptoms.”
He recommended driving with the windows up and turning on the recirculator switch. The air cabin filter should be kept clean if the car is equipped with one.
Though many balk at the idea as spring’s first warm evenings approach, Harper recommends sleeping with the windows closed.
“If you have the windows closed and the air conditioning on, that can be beneficial,” he said.
People who are sensitive to particulate should consider wearing sunglasses. “If you get particularly the wrap-around kind, that can limit the respiratory irritants from getting into the eyes,” Harper said.
Generally, though, Harper said people need to talk to their physicians, understand the potential risks of outdoor activity and limit activity when necessary even though it may not be the most popular option.
“It’s very difficult to tell a kid not to enjoy the summer,” Harper said.